Person-centered care is one of the primary factors associated with improved care and patient support (Kim, 2022). It is even more crucial for elderly patients as they need comprehensive psychological, social, and physical care and are also at a greater risk for developing complications. This essay will discuss the case of Sarah Smith, who is an 82- year old individual who has been admitted to the cardiology ward with unstable angina. The patient had a medical history of smoking, high blood pressure and cholesterol levels and unmanaged vitals. This paper will assess the care needs of Sarah and prioritize the nursing care and support. This paper will also outline preventable hospital complications and identify the need for adequate diet and nutrition with an evidence-based approach. Consideration for emotional and psychological support for Sarah will also be evaluated and included in this study. Effective discharge planning and patient education will also be summarised.
The patient has been admitted to the facility with the complication of angina that had begun with a sudden onset of chest pain along with epigastric distress. Nursing assessment for angina demands assessment of the location of pain and the characteristics of pain (ng et al., 2021). Primarily, an assessment of pain should be done using a pain scale, and the cause of the pain should be determined with a more comprehensive nursing assessment like a focussed cardiovascular and circulatory assessment of the patient (Heikkilä et al., 2019). The initial reading of the pain is at 6/10, indicating moderate to severe pain. This should be evaluated frequently to assess the effectiveness of the interventions developed. The immediate management should be focused on the care required to the patient. The blood pressure of Sarah is at 175/90mmHg, which should be 120/80mmHg (Eyikara & Baykara, 2018). The heart rate of the patient is 95 beats per minute. The respiratory rate of the patient is 24 breaths per minute, should be below 20 breaths per minute. These unregulated statistics can be associated with the severity of the pain (Yoost & Crawford, 2021). The high respiratory rate of the patient is high can also be associated with the anxiety of the patient. In the given case of Sarah, it can be deduced that there is a possibility that her angina was caused due to her epigastric issues. The priority should be to reduce the pain and to resolve the epigastric issues of the patient to stabilize the patient vitals (Potter et al., 2019). The general care focus should be based on ensuring stabilization of the healthcare needs of Sarah and focussing on improving pain and underlying complications with gastric issues.
Elderly patients are at a greater risk of developing complications in the care facilities and developing hospital-acquired infections (Conroy et al., 2021). This is primarily associated with the reduced immunity of elderly individuals and a greater risk of acquiring secondary infections in the care facility. In the given case, Sarah is an 82-year-old lady and thus is at risk of the same. Hence, to prevent the risk of infections for Sarah, it should be ensured that her environment is kept clean and aseptic. Hygiene protocols are followed necessarily, and an effective evaluation is ensured for the assessment of health and minimization of the risk of acquiring hospital-acquired complications. A BRADEN scale assessment should also be undertaken for Sarah for the assessment of the risk of development of pressure injuries. This will help in ensuring assessment of care needs Sarah and analysis of the overall healthcare needs (McKenna & Copnell, 2020).
It is the primary responsibility of the nurses to ensure that the care of the patient is maintained holistically (Ebrahim et al., 2021). This includes a focus on the nutritional and hydration needs of the patient as well. In the case of Sarah, the nutritional needs should be managed to focus on care on the epigastric issues. In addition, they are also needed in consideration with the medical history of the patient where the patient has hypercholesterolemia (Chenoweth et al., 2019). This is of primary consideration, and a history of hypercholesterolemia increases the risk of cardiovascular complications in the patients. The body fluid balance of the patient should be maintained, and optimum levels and care should be ensured (Yun & Choi, 2019). To monitor the food and nutrition choices of the patient, the focus should be on offering sufficient food choices to the patients and providing balanced meals. In addition, the development of supplements for nutritional needs and assessment of fluid balance and hydration also need to be taken into consideration. Support from diet specialists and nutritionists can be taken into consideration for the preparation of diet management and assuring a healthy water balance (Brown et al., 2020).
Sarah lives alone with her husband, who is 85 years old. Emotional and psychological support is core to effective care outcomes of the patients and is based on holistic care to the patients. Elderly individuals have a basic need to remain connected to the members of the family and friends (Molony et al., 2018). Social connections and communications among individuals are beneficial for the elderly population as it helps in minimizing their issues and promotes improved emotional stability. To ensure the provision of the elderly support for the care of Sarah, the primary need is to ensure the safety of the patients and to encourage their relationships with Sarah. In addition, a sense of community should be promoted for Sarah for inclusion of her husband in the process of care through shared decision making and support. The primary role of psychological support in nursing care is also associated with building rapport with the patients (Glas, 2019). Collaborative care is achieved by ensuring emotional support to the patients. This can make the patient feel comforted and can help in improving the healthcare outcomes of the patient (Grassi et al., 2019). As a nurse, Sarah should be engaged in the process of positive care and empathetic communication. Shared-decision making with the participation of Sarah and her husband should be taken into consideration. Sarah is afraid of injections. Hence, alternative medications should be proposed. In case alternatives are not available, education and support to Sarah should be ensured for healthcare outcomes and compliance of Sarah towards her needs. Sarah has anxiety and can thus feel restless at times. As a nurse, it should be ensured that person-centered practice is ensured to achieve suitable healthcare outcomes and improve the psychological wellbeing of Sarah.
The primary role of discharge planning is to ensure a connection between in-patient nurse care and follow-up for the out-patient care for the patients. This is inclusive of consideration for ensuring the patient and their families and carers are able to understand the individual care needs of the patients and are able to focus on long-term care goals. Discharge planning also helps in ensuring that the patient is able to recover effectively and the risk of rehospitalization is minimized (Molony et al., 2018). The process of discharge planning. The process of discharge planning should include patient assessment and the development of discharge plans based on the personalized care needs of the patients. This is also inclusive of focussing on the services and including the education needs of the patients and their families. In addition, follow-up evaluation also needs to be taken into consideration. In the case of Sarah, education should be given regarding her existing health problem and diet control. In addition, focus on diet management and frequent assessment of cholesterol levels also need to be taken into consideration. Education regarding medication management and medication adherence also needs to be outlined in the context of the same. Sarah is not keen on taking certain medications and is afraid of injections (Potter et al., 2019). This should be taken into consideration, and Sarah should be educated about the importance of medication consumption and the impact of non-adherence on the health of the patient.
Sarah and her husband also need to be educated about the signs of pain and experiences of gastric issues and congestion. This will help in the early identification of the risk of complications and help in preventing deterioration of the patient health. In addition, Sarah also needs to be educated about smoking cessation in the process of discharge planning and education. Smoking impacts the overall health of the individuals and also results in implications on the cardiovascular system. This can worsen the health outcomes of Sarah. Hence, a focus on smoking cessation needs to be laid in the context of health education. Focus on regulated diet and consumption of low-fat diet to control the hypercholesterolemia needs to be taken into consideration. Follow-up dates and need for frequent health assessment need to be highlighted for improved health outcomes (Conroy et al., 2019).
Conclusion
This paper highlights the case of Sarah, who has been diagnosed with angina after the complaints of epigastric issues. Angina is associated with chest pain, and Sarah is experiencing pain on a scale of 6/10. High intensity of pain has also resulted in complications with the vitals of the patient. This paper summarises the prioritization of the care needs of the patient and assessment of possible hospital-acquired complications. In addition, the importance of adequate hydration and nutrition as well as meeting the psychological needs and emotional needs of Sarah have also been determined. A holistic approach has been developed in consideration for Sarah for discharge planning and emotional support to ensure improved healthcare outcomes.
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